Abstract

Background

The aim of this study was to measure six months compliance to Swedish clinical guidelines
in psychiatric care after an active supported implementation process, using structured
measures derived from the guidelines.

Methods

In this observational study four psychiatric clinics each participated in active implementation
of the clinical guidelines for the assessment and treatment of depression and guidelines
for assessment and treatment of patients with suicidal behaviours developed by The
Stockholm Medical Advisory Board for Psychiatry. The implementation programme included
seminars, local implementation teams, regular feedback and academic visits. Additionally
two clinics only received the guidelines and served as controls. Compliance to guidelines
was measured using indicators, which operationalised requirements of preferred clinical
practice. 725 patient records were included, 365 before the implementation and 360
six months after.

Results

Analyses of indicators registered showed that the actively implementing clinics significantly
improved their compliance to the guidelines. The total score differed significantly
between implementation clinics and control clinics for management of depression (mean
scores 9.5 (1.3) versus 5.0 (1.5), p < 0.001) as well as for the management of suicide
(mean scores 8.1 (2.3) versus 4.5 (1.9), p < 0.001). No changes were found in the
control clinics and only one of the OR was significant.

Conclusion

Compliance to clinical guidelines measured by process indicators of required clinical
practice was enhanced by an active implementation.